The opioid crisis has grown far beyond Purdue Pharma’s legal saga

TThe world of drug policy has been torn apart by the Supreme Court pronunciation Thursday that Purdue Pharma’s bankruptcy settlement could not move forward if it included legal protections for the company’s billionaire owners.

In one camp are those who would like to see the agreed-upon $6 billion settlement put into effect to prevent and treat opioid addiction. In the other group are those who found the prospect of protecting the Sackler family from civil lawsuits indefensible.

But there’s also a third camp: one that claims that Purdue, the infamous pain drug OxyContin, and the overall scandal are of little consequence to the current overdose epidemic, in which fentanyl, methamphetamine, and other illegal drugs together kill more than 110,000 Americans. year.

“I will not argue with the emotional stance of a grieving parent who has lost a child to OxyContin,” said Stefan Kertesz, an addiction specialist and professor of medicine at the University of Alabama-Birmingham. “But what got us into this crisis and what will get us out of it is far bigger than executing a revenge plan against a company’s owners.”

With Thursday’s ruling, Purdue and many of the attorneys general who sued the company vowed to restart negotiations on a new settlement agreement. But the clean slate has advocates questioning whether pursuing justice for the dead, accountability for the Sacklers and preventing future deaths are fully compatible goals.

Since the opioid crisis captured the nation’s attention, the Sacklers have been the focus of countless books, television shows and protests calling for the family name to be removed from countless art museums and university buildings.

But even as the Sacklers fell under the spell, the drug crisis turned from OxyContin to heroin and later from heroin to fentanyl. Meanwhile, the U.S. has sharply reduced opioid prescribing — which Kertesz and many pain patients say has now created a secondary crisis by driving Americans from regulated, predictable painkillers to unregulated, volatile opioids like fentanyl.

“Where we are now is that the vast majority of people are not dying from prescription opioids,” said Sara Whaley, a researcher who focuses on substance use policy at the Johns Hopkins School of Public Health. “Our crisis is primarily illicitly manufactured synthetic opioids, such as fentanyl.”

The financing landscape has also changed as other pharmaceutical companies, drug wholesalers and pharmacies have also agreed to settle claims related to their role in the opioid crisis. These settlements total about $50 billion, some of which now flows to governments and community organizations.

While pursuing justice for the Sacklers may be cathartic, Kertesz argued, it is unclear whether the Sacklers’ status as a national pariah motivates the kind of systemic change necessary — or whether, in his view, it is simply another “quick fix” .

Instead, Kertesz said, the country needs a major overhaul of its health care system, emphasizing listening to patients and using proven remedies like the addiction drug buprenorphine to help prevent future overdose deaths.

The U.S. health care system “has helped create health care payment plans that penalize time spent listening to patients and learning about their problems, while rewarding quick visits and high tech,” he said. “Those were policy decisions that were being negotiated in organized medicine long before Purdue Pharma came along to exploit them. And the reality is that no one is trying to solve them.”

Yet the Supreme Court’s 5-4 decision to derail Purdue’s settlement process leaves in flux $6 billion that cannot yet be used for naloxone treatment, prevention or distribution. It also delays significant payments to thousands of individual plaintiffs who have sued Purdue over lost loved ones.

And while the current drug crisis bears little resemblance to the one Sparked by Purdue long ago, it’s easy to draw a line from one to the other, Whaley said.

“Where we are today is a product of what happened with Purdue 20 years ago,” she said. “They are two separate things, but the impact these settlements are having today is that they result in additional resources that state and local governments can invest back into communities to address the crisis.”

For the loved ones of many recent overdose victims, Purdue and OxyContin do not represent an earlier phase of the drug crisis, but rather an inescapable trauma.

“It’s very raw for me and for a lot of families,” said Dita Bhargava, a parent advocate with the nonprofit Shatterproof. Her eldest son, Alec, died in 2018 at the age of 26. According to her, his addiction started with OxyContin.

The pain of recent loss, coupled with the continued devastation of the current drug crisis, has left many members of the addiction and drug policy communities in an impossible situation.

“It’s not clear: there are a lot of advocates who felt like we needed that money right away,” Bhargava said. “We do. There are so many people who are suffering helplessly. But on the other hand, there are many advocates – and to some extent I felt that way, and I still feel that way – who feel that the Sacklers in the broadest sense of the word law must be held accountable.’

It is a choice no one should have to make, Bhargava said. The $6 billion is a “drop in the bucket” by federal spending standards, she added, and adequately responding to the overdose crisis should not come at the expense of holding the Sacklers accountable, or vice versa.

Perhaps as important as the funds, Bhargava and others said, is the message the ultimate end of the Purdue case will send: namely, whether it serves as a lasting warning to potential corporate wrongdoers, or instead suggests that a sufficiently high dollar amount of their misdeeds.

“Will it really make a difference from a public health perspective? Maybe not,” said Regina LaBelle, a former senior drug policy official in the Obama and Biden administrations and director of the Addiction and Public Policy Initiative at the O’Neill Institute in Georgetown. “But the legal system is about accountability and upholding the rule of law.”

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